Title X (Public Health Service Act) Family Planning Program

Angela Napili
Information Research Specialist

The federal government provides grants for voluntary family planning services through the Family Planning Program, Title X of the Public Health Service Act, codified at 42 U.S.C. Section 300 to Section 300a-6. The program, enacted in 1970, is the only domestic federal program devoted solely to family planning and related preventive health services. Title X is administered through the Office of Population Affairs (OPA) under the Office of the Assistant Secretary for Health in the Department of Health and Human Services (DHHS).

Although the authorization of appropriations for Title X ended with FY1985, funding for the program has continued to be provided through appropriations bills for the Departments of Labor, Health and Human Services, and Education, and Related Agencies (Labor-HHS-Education). Within DHHS, Title X receives its funding through the Health Resources and Services Administration (HRSA) account.

The President’s FY2013 Budget requests $296.838 million for Title X, 1% more than the FY2012 funding level. The Senate-reported FY2013 Labor-HHS-Education Appropriations bill, S. 3295, would provide $293.870 million. FY2012 funding for Title X is $293.870 million, 2% less than the FY2011 funding level of $299.400 million. The Consolidated Appropriations Act, 2012 (P.L. 112-74) continues previous years’ requirements that Title X funds not be spent on abortions, that all pregnancy counseling be nondirective, and that funds not be spent on promoting or opposing any legislative proposal or candidate for public office. Grantees continue to be required to certify that they encourage “family participation” when minors seek family planning services, and certify that they counsel minors on how to resist attempted coercion into sexual activity. The law also clarifies that family planning providers are not exempt from state notification and reporting laws on child abuse, child molestation, sexual abuse, rape, or incest.

The law (42 U.S.C. §300a-6) prohibits the use of Title X funds in programs where abortion is a method of family planning. According to OPA, family planning projects that receive Title X funds are closely monitored to ensure that federal funds are used appropriately and that funds are not used for prohibited activities such as abortion. The prohibition on abortion does not apply to all the activities of a Title X grantee, but only to activities that are part of the Title X project. A grantee’s abortion activities must be “separate and distinct” from the Title X project activities.

Several bills addressing Title X have been introduced in the 112th Congress. H.R. 217 and S. 96 would prohibit Title X grants to abortion-performing entities. H.R. 408 and S. 178 would eliminate the Title X program. H.R. 1099 would prohibit federal spending on any family planning activity. H.R. 1135, H.R. 1167, and S. 1904 would require an overall spending limit on meanstested welfare programs, defined to include family planning. S. 814 would require online disclosure of audits conducted under Title X on any entity receiving Title X funds. H.R. 5650 would prohibit Title X grantees and contractors from discriminating against a health care entity on the basis of whether it separately provides or refers for abortions, provides employees coverage of abortions, or provides or requires training in performing abortions. H.R. 1 would have eliminated funding for Title X for FY2011. H.R. 1 and H.Con.Res. 36 would have restricted federal funding to the Planned Parenthood Federation of America (PPFA) and its affiliates for FY2011. The House-introduced FY2012 Labor-HHS-Education Appropriations bill, H.R. 3070, would have prohibited the bill’s funds from being used for Title X. H.R. 3070 would have also restricted the bill’s funding to PPFA and its affiliates unless they certify that the organization will not perform abortions.


Date of Report: June 18, 2012
Number of Pages: 27
Order Number: RL33644
Price: $29.95

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U.S. Response to the Global Threat of HIV/AIDS: Basic Facts

Alexandra E. Kendall
Analyst in Global Health

The human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) is one of the world’s most pressing global health challenges. Since the beginning of the epidemic, more than 60 million people have been infected with HIV, approximately 30 million of whom have died of HIV-related causes. At the end of 2010, an estimated 34 million people were living with the virus, the vast majority of whom live in sub-Saharan Africa. Expanded access to antiretroviral therapy (ART) over the past decade, due in large part to U.S. support, has contributed to declines in deaths among people living with HIV. Nonetheless, new infections continue to outpace access to treatment. The second session of the 112th Congress will likely be faced with determining how, and to what extent, the United States should respond to the continued challenge of global HIV/AIDS.

The United States has recognized HIV/AIDS as a key foreign policy priority. Congress has passed several pieces of legislation related to global HIV/AIDS prevention, treatment, and care. In particular, in 2003, Congress enacted the U.S. Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of 2003 (P.L. 108-25), authorizing $15 billion to combat global HIV/AIDS, tuberculosis (TB), and malaria through the President’s Emergency Plan for AIDS Relief (PEPFAR), an initiative proposed by the George W. Bush Administration. In 2008, Congress enacted the Tom Lantos and Henry J. Hyde United States Global Leadership Against HIV/AIDS, Tuberculosis, and Malaria Reauthorization Act of 2008 (P.L. 110-293), authorizing $48 billion for HIV/AIDS, TB, and malaria programs from FY2009 through FY2013.

PEPFAR is the largest commitment in history by any nation to combat a single disease and makes up the majority of donor funding for global HIV/AIDS. When PEPFAR was announced, health experts were debating whether the international community had a responsibility to provide ART in developing countries and whether they could be safely administered in such environments. PEPFAR responded to calls from those advocating treatment for the world’s poor and demonstrated that ART could be effectively provided in low-resource settings.

PEPFAR is coordinated by the Office of the U.S. Global AIDS Coordinator (OGAC) at the Department of State and is implemented by a range of U.S. agencies that include, among others, the United States Agency for International Development (USAID) and the Centers for Disease Control and Prevention (CDC). The United States also supports several multilateral organizations responding to HIV/AIDS, including the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) and the United Nations Joint Program on HIV/AIDS (UNAIDS).

Due in part to the global response to HIV/AIDS, substantial progress has been made in combating the epidemic. New HIV infections fell by more than 25% in 33 countries between 2001 and 2009, and a total of 2.5 million deaths have been averted in low- and middle-income countries since 1995 due to antiretroviral therapy. At the same time, major challenges remain in the fight against HIV/AIDS. For example, with new infections outpacing available treatment, experts have increasingly debated how to best allocate limited resources. This report outlines basic facts related to global HIV/AIDS, including characteristics of the epidemic and U.S. legislation, programs, funding, and partnerships related to global HIV/AIDS. It concludes with a brief description of some of the major issues that might be considered by the 112th Congress in its response to the disease.


Date of Report: June 15, 2012
Number of Pages: 16
Order Number: R41645
Price: $29.95

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U.S. Response to the Global Threat of Malaria: Basic Facts

Alexandra E. Kendall
Analyst in Global Health

In 2010, malaria infected an estimated 216 million people and killed 655,000 people, most of whom were children under the age of five in sub-Saharan Africa. Despite the current burden of disease, malaria is preventable and treatable. Congress has increasingly recognized malaria as an important foreign policy issue, and the United States has become a major player in the global response to the disease. In its second session, the 112th Congress will likely debate the appropriate funding levels and optimum strategy for addressing the continued challenge of global malaria.

Congress has enacted several key pieces of legislation related to global malaria control. These include the Assistance for International Malaria Control Act of 2000 (P.L. 106-570); the U.S. Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of 2003 (P.L. 108-25); and the Tom Lantos and Henry J. Hyde United States Global Leadership Against HIV/AIDS, Tuberculosis, and Malaria Reauthorization Act of 2008 (P.L. 110-293). These acts have authorized funds to be used in the fight against malaria and have shaped the ways in which U.S. malaria programs are coordinated and managed, including through the creation of the U.S. Global Malaria Coordinator at the United States Agency for International Development (USAID).

In 2005, in response to growing international calls for global malaria control and to the success of the President’s Emergency Plan for AIDS Relief (PEPFAR), President George W. Bush launched the President’s Malaria Initiative (PMI), which aims to halve the burden of malaria morbidity and mortality in 70% of at-risk populations in sub-Saharan Africa by 2014. PMI brought significant new attention and funding to U.S. malaria programs and made the United States one of the largest donors for malaria efforts. While U.S. funding for global malaria programs has increased each fiscal year since FY2004, support for malaria interventions increased most precipitously beginning in FY2007 as PMI has expanded into new countries. President Obama has continued to support PMI through the Global Health Initiative (GHI).

There is evidence that the growing international response to malaria has had some success in controlling the epidemic. Since 2000, global malaria incidence has decreased by 17% and malaria mortality by 26%. Since 2000, 43 countries have reported a reduction in reported malaria cases of more than 50%, including eight African countries that have experienced 50% reduction in either confirmed malaria cases or malaria admissions and deaths. The decreases in each of these African countries are associated with intense malaria control activities. Despite these successes, several key issues pose challenges to an effective scale-up of the response to malaria. First, increasing reports of drug-resistant malaria in Southeast Asia and insecticide-resistant mosquitoes, largely in Africa, threaten the success of malaria control programs. Second, weak health systems, including shortages in health care personnel and inadequate supply chain networks, have limited the delivery of essential commodities for malaria control. There is also debate within the global health community over whether malaria efforts should increasingly target areas where malaria elimination is possible or whether efforts should remain concentrated on malaria control.

This report outlines basic facts related to global malaria, including characteristics of the epidemic and U.S. legislation, programs, funding, and partnerships related to the global response to malaria.


Date of Report: June 15, 2012
Number of Pages: 13
Order Number: R41644
Price: $29.95

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U.S. Response to the Global Threat of Tuberculosis: Basic Facts

Alexandra E. Kendall
Analyst in Global Health

Tuberculosis (TB) is one of the most widespread infectious diseases in the world, infecting an average of 9 million people annually. Although TB is curable, more than 1 million TB-related deaths occur each year. Due in part to a growing global response to TB, progress has been made in combating the disease. Globally, new TB infection rates have begun to slowly decline and TB mortality rates have decreased significantly since 1990. At the same time, absolute numbers of people infected with TB, particularly in Asia and Africa, continue to rise. Congress has recognized TB as an important humanitarian issue and increasingly as a potential threat to global security. In its second session, the 112th Congress will likely debate the appropriate funding levels and optimum strategy for addressing the continued challenge of global TB.

Congress has enacted several key pieces of legislation related to the prevention, treatment, and care of people with TB around the world. These include the Global AIDS and Tuberculosis Relief Act of 2000 (P.L. 106-264); the U.S. Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of 2003 (P.L. 108-25); and the Tom Lantos and Henry J. Hyde United States Global Leadership Against HIV/AIDS, Tuberculosis, and Malaria Reauthorization Act of 2008 (P.L. 110- 293). These acts have authorized funds to be used in the fight against global TB and have recommended priority areas for the use of these funds.

From FY2004 to FY2007, U.S. spending for global TB remained at around $90 million per fiscal year. TB received new attention as a critical issue in May 2007, when a man known to be carrying a drug-resistant form of the disease was able to cross several international borders, putting dozens of others at risk of infection. In response to this event and to growing recognition of the global threat posed by TB, congressional funding for global TB began to increase significantly in FY2008, when Congress provided $163.1 million to USAID for its TB programs and directed the State Department to spend at least $150 million of funds for the President’s Emergency Plan for AIDS Relief (PEPFAR) on joint HIV/TB programs. Funding for global TB saw steady increases from FY2008 to FY2010 and has seen small fluctuations since.

The United States Agency for International Development (USAID) is the lead U.S. agency in global TB control and oversees bilateral programs in over 40 countries. The United States works closely with a range of multilateral partners in responding to global TB, including the World Health Organization (WHO) and the Global Fund to Fight AIDS, Tuberculosis, and Malaria (Global Fund), the largest external donor for TB. National governments play a critical role in responding to TB, and domestic government expenditures account for the majority of global TB funding.

Several key issues threaten global control of TB. First, HIV/TB co-infection, particularly in Africa, is a growing challenge. TB is the leading cause of death for people with HIV, and TB control is significantly impeded in areas with high HIV prevalence. Second, drug-resistant forms of TB, including multidrug-resistant TB (MDR-TB) and extensively drug-resistant TB (XDRTB), are more difficult and expensive to treat, leading to greater TB-related mortality. Finally, the methods currently used for both TB diagnosis and treatment are antiquated and have varying degrees of success, particularly in the face of HIV/TB co-infection and drug-resistant TB. This report outlines basic facts related to global TB, including characteristics of the epidemic and U.S. legislation, programs, funding, and partnerships related to the global response to TB.


Date of Report: June 15, 2012
Number of Pages: 15
Order Number: R41643
Price: $29.95

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Document available via e-mail as a pdf file or in paper form.
To order, e-mail Penny Hill Press or call us at 301-253-0881. Provide a Visa, MasterCard, American Express, or Discover card number, expiration date, and name on the card. Indicate whether you want e-mail or postal delivery. Phone orders are preferred and receive priority processing.

Title X (Public Health Service Act) Family Planning Program

Angela Napili
Information Research Specialist

The federal government provides grants for voluntary family planning services through the Family Planning Program, Title X of the Public Health Service Act, codified at 42 U.S.C. Section 300 to Section 300a-6. The program, enacted in 1970, is the only domestic federal program devoted solely to family planning and related preventive health services. Title X is administered through the Office of Population Affairs (OPA) under the Office of the Assistant Secretary for Health in the Department of Health and Human Services (DHHS).

Although the authorization of appropriations for Title X ended with FY1985, funding for the program has continued to be provided through appropriations bills for the Departments of Labor, Health and Human Services, and Education, and Related Agencies (Labor-HHS-Education). Within DHHS, Title X receives its funding through the Health Resources and Services Administration (HRSA) account.

The President’s FY2013 Budget requests $296.838 million for Title X, 1% more than the FY2012 funding level. FY2012 funding for Title X funding is $293.870 million, 2% less than the FY2011 funding level of $299.400 million. The Consolidated Appropriations Act, 2012 (P.L. 112-74) continues previous years’ requirements that Title X funds not be spent on abortions, that all pregnancy counseling be nondirective, and that funds not be spent on promoting or opposing any legislative proposal or candidate for public office. Grantees continue to be required to certify that they encourage “family participation” when minors seek family planning services, and certify that they counsel minors on how to resist attempted coercion into sexual activity. The law also clarifies that family planning providers are not exempt from state notification and reporting laws on child abuse, child molestation, sexual abuse, rape, or incest.

The law (42 U.S.C. §300a-6) prohibits the use of Title X funds in programs where abortion is a method of family planning. According to OPA, family planning projects that receive Title X funds are closely monitored to ensure that federal funds are used appropriately and that funds are not used for prohibited activities such as abortion. The prohibition on abortion does not apply to all the activities of a Title X grantee, but only to activities that are part of the Title X project. A grantee’s abortion activities must be “separate and distinct” from the Title X project activities.

Several bills addressing Title X have been introduced in the 112th Congress. H.R. 217 and S. 96 would prohibit Title X grants to abortion-performing entities. H.R. 408 and S. 178 would eliminate the Title X program. H.R. 1099 would prohibit federal spending on any family planning activity. H.R. 1135, H.R. 1167, and S. 1904 would require an overall spending limit on meanstested welfare programs, defined to include family planning. S. 814 would require online disclosure of audits conducted under Title X on any entity receiving Title X funds. H.R. 1 would have eliminated funding for Title X for FY2011. H.R. 1 and H.Con.Res. 36 would have restricted federal funding to the Planned Parenthood Federation of America and its affiliates for FY2011. The House-introduced FY2012 Labor-HHS-Education Appropriations bill, H.R. 3070, would have prohibited the bill’s funds from being used for Title X. H.R. 3070 would have also restricted the bill’s funding to Planned Parenthood Federation of America and its affiliates unless they certify that the organization will not perform abortions. H.R. 5650 would prohibit Title X grantees and contractors from discriminating against a health care entity on the basis of whether it separately provides or refers for abortions, provides employees coverage of abortions, or provides or requires training in performing abortions.


Date of Report: June 14, 2012
Number of Pages: 27
Order Number: RL33644
Price: $29.95

Follow us on TWITTER at http://www.twitter.com/alertsPHP or #CRSreports

Document available via e-mail as a pdf file or in paper form.
To order, e-mail Penny Hill Press or call us at 301-253-0881. Provide a Visa, MasterCard, American Express, or Discover card number, expiration date, and name on the card. Indicate whether you want e-mail or postal delivery. Phone orders are preferred and receive priority processing.